CPT® Code 36823

Insertion of arterial and venous cannula(s) for isolated extracorporeal circulation including regional chemotherapy perfusion to an extremity, with or without hyperthermia, with removal of cannula(s) and repair of arteriotomy and venotomy sites

The procedure described by CPT® Code 36823 involves the insertion of arterial and venous cannulae for the purpose of facilitating isolated extracorporeal circulation, which is a technique used to direct blood flow outside the body for various medical interventions. This procedure is particularly relevant in the context of regional chemotherapy perfusion to an extremity, allowing for targeted delivery of chemotherapy agents while minimizing systemic exposure. The process begins with the administration of a systemic anticoagulant to prevent blood clotting during the procedure. The major inflow and outflow vessels, typically located in the extremity, are identified and accessed through an incision in the skin. Once the vessels are exposed, they are incised to allow for the insertion of cannulas; the arterial cannula facilitates inflow, while the venous cannula manages outflow. In some cases, a percutaneous technique may be employed to access the blood vessels, which involves using a needle to puncture the skin and gain access to the vessels without a large incision. To control blood flow from collateral vessels, a tourniquet is applied temporarily. The isolation of the extremity from systemic circulation is confirmed through various techniques, such as the injection of contrast material or the use of radiolabeled red blood cells or serum, ensuring that the chemotherapy agent is delivered effectively to the targeted area. If hyperthermia is part of the treatment plan, temperature probes are placed to monitor the extremity's temperature, which is then elevated to the desired level to enhance the efficacy of the chemotherapy. After the procedure is completed, the cannulas are carefully removed, and the sites of arteriotomy and venotomy are repaired to ensure proper healing and minimize complications.